Abstract
Purpose: To evaluate and compare the effect of arthroscopic depridement and lavage versus arthroscopic lavage only as a treatment in osteoarthritis of the knee.
Type of Study: A prospective study.
Material and Methods: 500 patients ( mean age 58 years ) were available for 6 years follow-up after arthroscopy of the knee as a treatment of osteoarthritis refractory to conservative treatment. 250 patients were treated with debridement and lavage and 250 patients were treated with lavage only.
Osteoarthritis of the knee is a common cause of knee pain. The pain from osteoarthritis is due to synovitis, capsular and ligamentous inflammation, and subchondral bone pain because cartilage has no nerves.
Degenerative arthritis is usually the end result of mechanical stress inflicted on the articular cartilage, either through a suddenly applied single load or through the cumulative effect of multiple or repetitive loads leads to breakdown of the articular cartilage.
The treatment of knee pain due to osteoarthritis of the knee includes conservative treatment such as rest, weight loss, physical therapy, nonsteroidal anti-inflammatory drugs, Cox-II inhibitors, nutritional supplements, steroid injections, Viscosupplementation, and surgical treatment such as arthroscopy, osteotomy or arthroplasty. With failure of conservative treatment, arthroscopic debridement and lavage is the treatment of choice for such patients.
Results: Arthroscopic debridement and lavage performed in earlier stages of osteoarthritis of the knee resulted in significant reduction of pain for long period of time. In advanced stages of osteoarthritis, patients experienced less pain relief for shorter period of time. Debridement and lavage was superior to lavage only at 6 years in reduction of pain.
In my group 93.8% (91.2% of the lavage group and 96.4% of the debridement group) were satisfied at 6 months and felt better than before their surgery, at 3 years 45.6% (35.6% of the lavage group and 55.6% of the debridement group) felt better, and at 6 years 30.2% (22.8% of the lavage group and 37.6% of the debridement group) felt better after the arthroscopic procedure.
Conclusions: Arthroscopic debridement and lavage of painful osteoarthritic knees has a better outcome than lavage only for the same treatment, however patients must be made aware that the procedure is not curative and that it is quite possible that they will need further surgery in the future. Arthroscopic surgery (debridement and lavage or even lavage only) is reasonably successful temporizing and palliative procedure. However, the patient must be informed about the prospects of success, the benefits, the alternative and the risks of that procedure.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
